In-flight Medical Emergencies.

In 2018, approximately 2.8 million passengers flew in and out of U.S. airports per day. Twenty-four to 130 in-flight medical emergencies are estimated to occur per 1 million passengers; however, there is no internationally agreed-upon recording or classification system. Up to 70% of in-flight emergencies are managed by the cabin crew without additional assistance. If a health care volunteer is requested, medical professionals should consider if they are in an appropriate condition to render aid, and then identify themselves to cabin crew, perform a history and physical examination, and inform the cabin crew of clinical impressions and recommendations. An aircraft in flight is a physically constrained and resource-limited environment. When needed, an emergency medical kit and automated external defibrillator are available on all U.S. aircraft with at least one flight attendant and a capacity for 30 or more passengers. Coordinated communication with the pilot, any available ground-based medical resources, and flight dispatch is needed if aircraft diversion is recommended. In the United States, medical volunteers are generally protected by the Aviation Medical Assistance Act of 1998. There is no equivalent law governing international travel, and legal jurisdiction depends on the patient's and medical professional's countries of citizenship and the country in which the aircraft is registered.

Pandora's box closed: The Royal Air Force Institute of Aviation Medicine and Nazi medical experiments on human beings during World War II.

In the months before and after the final surrender of Nazi Germany on 8 May 1945, British aviation medicine specialists were sent to the European continent to learn the progress that German aviation medicine had made since September 1939. For the medical officers at the Royal Air Force Institute of Aviation Medicine at Farnborough in Hampshire, the dilemma over whether the medical data from the Nazi aviation medicine experiments at Dachau concentration camp should be exploited presented profound moral and ethical problems. Their deliberations paralleled those of the 1945-46 Nuremberg Trial, which revealed the crimes that were committed under the Nazi regime. At the same time, the British medical establishment debated the morality of publishing the Nazi medical research to serve humanity. This article shows that on the basis of British wartime and post-war research, and determinations that were made by the British Advisory Committee for the Investigation of German Medical War Crimes, by 1948 the RAF IAM had essentially rejected the results of the Nazi aviation medicine experiments on scientific and ethical grounds.

Should NASA Collect Astronauts' Genetic Information for Occupational Surveillance and Research?

Humans exploring beyond low-Earth orbit face environmental challenges coupled with isolation, remote operations, and extreme resource limitations in which personalized medicine, enabled by genetic research, might be necessary for mission success. With little opportunity to test personalized countermeasures broadly, the National Aeronautics and Space Administration (NASA) will likely need to rely instead on collection of significant amounts of genomic and environmental exposure data from individuals. This need appears at first to be in conflict with the statutes and regulations governing the collection and use of genetic data. In fact, under certain conditions, the Genetic Information Nondiscrimination Act (GINA) of 2008 allows for the use of genetic information in both occupational surveillance and research and in the development of countermeasures such as personalized pharmaceuticals.

Grounded for an ethical dilemma: disequilibrium in a commercial airline pilot.

This article presents the case of a 41-year-old airline pilot with benign paroxysmal positional vertigo who requests that his diagnosis not be disclosed to his commercial airline employer or his aviation medical examiner because it may result in the suspension of medical certification. The legal and ethical requirements for physicians reporting impaired pilots are discussed as well as practical recommendations for handling such situations. The argument is made that a physician's obligation to honor patient confidentiality should not take precedence over his or her duty to protect the safety and well-being of the airplane passengers and the general public. If the patient chooses not to self-report, a physician has an ethical obligation to report the patient's medical condition to the Federal Aviation Administration.

The bioethics of enhancing human performance for spaceflight.

There are many ways of enhancing human performance. For military aviation in general, and for spaceflight in particular, the most important tools are selection, training, equipment, pharmacology, and surgery. In the future, genetic manipulation may be feasible. For each of these tools, the specific modalities available range from the ethically acceptable to the ethically unacceptable. Even when someone consents to a particular procedure to enhance performance, the action may be ethically unacceptable to society as a whole and the burden of risk for the individual may be too great. In addition, there are several characteristics that define the quality and the acceptability of the consent. Each method of enhancing performance will be examined in the context of the principles of medical ethics in a western society: autonomy, non-maleficence, beneficence, and justice. The aim is to draw the attention of aeromedical practitioners to the complexities of ethical dilemmas such as this particular one in order to help them to develop a morally justifiable code of practice that balances society's needs against individual ambitions and corporate goals.

Ethics in human experimentation: the two military physicians who helped develop the Nuremberg Code.

The Nuremberg Code is generally considered the beginning of modern ethics in human experimentation. The Code is a list of 10 principles that Judge Walter Beals included in the judgment he delivered at the close of the Nuremberg Medical Trial on 19 August 1947. Recently, scholars have studied the origin of the Code, who wrote it, and why. This is important to military medicine and the Aerospace Medical Association in particular because many of the defendants claimed their crimes were experiments in aviation and environmental physiology conducted under wartime conditions. The chief prosecutor of the Nuremberg Medical Trial, General Telford Taylor, relied on the guidance of an advisor provided by the American Medical Association, Andrew C. Ivy, one of the foremost physiologists of his time. The neurologist, Leo Alexander, then a colonel in the U.S. Army Reserves, was another medical advisor. Both men were crucial to the development of Taylor's courtroom strategy. The material Alexander and Ivy provided was incorporated verbatim in the section of the judgment that became the Code. Although both men contributed to the Code, Ivy provided what seems to be the first formulation of many of these principles during a meeting of Allied medical investigators at the Pasteur Institute in July 1946. Naval researchers should note that Ivy had been the Director of the Research Division of the Naval Medical Research Institute when it was commissioned on October 27, 1942.

Medical confidentiality and human immunodeficiency virus (HIV) infection: a hypothetical case.

This paper describes a hypothetical case of a HIV positive pilot. It explores legal and ethical aspects of medical confidentiality and discusses who, inside and outside military and medical circles, can be told of his condition in the light of the particular circumstances. Disclosure without the patient's consent is a serious step that should not be undertaken without advice from Service medico-legal departments and medical protection organisations.

Medicina aeronáutica y seguridad aérea I: Una visión global contemporánea / No disponible

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